SSM Health Care St. Louis
Organization Active NPI Emergency Medicine Physician · Saint Louis, MO
NPI 1366400855 · NPPES record last updated Jun 2, 2026
Key facts
- NPI
- 1366400855
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- Legal business name
- SSM HEALTH CARE ST. LOUIS
- Practice address
- 6420 Clayton Rd
Saint Louis, MO 63117-1811 - Phone
- (314) 768-8000
- NPI assigned
- May 3, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- SSM HEALTHCARE ST. LOUIS
Authorized official
- Name
- Karen Rewerts
- Title
- VP Finance
- Phone
- (314) 768-8000
Owned or controlled facilities with NPI records 12
Other NPIs on the same Medicare enrollment 5
Other NPIs with the same Medicare PAC ID 13
Practitioners 352
-
Logan A Frank, M.D.
-
Amanda Marie Sauer, WHNP-BC
-
Melissa Rae Mitchell, WHNP
-
Jennifer Goldkamp, M.D.
-
Justine Keller, MD
-
Kia S Lannaman, MD
-
Chetana M Reddy, MD
-
Corenthian Jerome Booker, M.D.
-
Annelee Boyle, M.D.
-
Gary Andrew Dildy III, M.D.
-
Jacqueline H Grant, MD, MPH, MPA
-
Barbara Head, MD
-
James A Thorp, MD
-
Kristy Wienstroer, WHNP
-
Brendan Alleyne, MD
-
Issam Atallah, MD
-
Helen R Evans, FNP-C
-
Danielle Nicole Garcia, WHNP-BC
-
Amanda B Gordon, FNP
-
Samrat Jun Jayanth, M.D.
-
Joseph F Kras, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MO, IL
All facility ownership & control disclosures 11
| Facility | Type | Role | Since |
|---|---|---|---|
| SSM Health St. Clare Hospital - Fenton |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2015 |
| SSM Health Rehabilitation Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (49%) | May 1, 2009 |
| SSM Health Saint Louis University Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2015 |
| SSM Health Saint Louis University Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2015 |
| SSM Health St Joseph Hospital - Lake Saint Louis |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Sep 17, 2014 |
| SSM Health St Joseph Hospital - St Charles |
Hospital | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Sep 11, 1984 Oct 12, 2015 |
| SSM Health St. Mary'S Hospital - St. Louis |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jan 13, 2014 |
| SSM Health St. Mary'S Hospital - St Louis |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Sep 11, 1984 |
| SSM Health Depaul Hospital St Louis |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Dec 16, 2013 |
| SSM Health Depaul Hospital - St Louis |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Oct 10, 2014 |
| SSM Health Depaul Hospital - Anna House |
Skilled nursing facility | 5% Or Greater Indirect Ownership Interest (100%) | Sep 1, 2015 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031118000393 | MO | Part B Supplier - Clinic/Group Practice | 7810800737 |
Receives reassigned benefits from 776 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Maryland Heights, MO; O Fallon, MO; Saint Charles, MO; Florissant, MO; Saint Louis, MO; Wentzville, MO; Bridgeton, MO; Arnold, MO… |
| O20171004000007 | IL | Part B Supplier - Clinic/Group Practice | 7810800737 |
Receives reassigned benefits from 17 practitioners Practice locations: O Fallon, IL |
National Provider Directory
- Part of
- Good Samaritan RHC Wayn
Locations
900 E Walnut St
Ste 5
Carbondale, IL 62901
Phone (618) 519-9182
7263 Solutions Ctr
Chicago, IL 60677
7344 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-6189
7334 Solutions Ctr
Chicago, IL 60677
2133 Vadalabene Dr
Ste 1
Maryville, IL 62062
Phone (618) 288-4350
12277 De Paul Dr
Ste 200
Bridgeton, MO 63044
Phone (314) 291-3399
3440 De Paul Ln
Ste 100
Bridgeton, MO 63044
Phone (314) 739-0924
683 Big Bend Rd
Manchester, MO 63021
Phone (636) 227-1511
2024 Dorsett Vlg
Maryland Heights, MO 63043
Phone (314) 590-0550
300 1st Capitol Dr
Ste 221
Saint Charles, MO 63301
330 1st Capitol Dr
Ste 210
Saint Charles, MO 63301
Phone (636) 947-2334
1173 Corporate Lake Dr
Saint Louis, MO 63132
1035 Bellevue Ave
Ste 305
Saint Louis, MO 63117
Phone (314) 644-6161
1235 E Cherokee St
Springfield, MO 65804
Phone (417) 820-2115
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician |
207P00000X | Yes | ||
| Internal Medicine Physician |
207R00000X | |||
| Cardiovascular Disease Physician |
207RC0000X | |||
| Pulmonary Disease Physician |
207RP1001X | |||
| Nuclear Medicine Physician |
207U00000X | |||
| Cytopathology Physician |
207ZC0500X | |||
| Multi-Specialty Clinic/Center | 261QM1300X |
Addresses
Primary practice location
6420 Clayton Rd
Saint Louis, MO 63117-1811
Mailing address
1145 Corporate Lake Dr
Saint Louis, MO 63132-2907
Phone (314) 989-6189
Other practice location 1
900 E Walnut St Ste 5
Carbondale, IL 62901-3132
Phone (618) 519-9182
Other practice location 2
1035 Bellevue Ave Ste 205
Saint Louis, MO 63117-1846
Phone (314) 768-8230
Other practice location 3
1191 Fortune Blvd Ste 1
O Fallon, IL 62269-7377
Phone (618) 206-6101
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 540326204 | Medicaid | MO | |
| 3285 | Other | MO | GHP GROUP NUMBER |
Other names
- SSM Health St. Mary's Hospital Physician Billing
Other providers in Saint Louis, MO
- SSM Health Care Group
- SSM Health Care Group
- SSM Health Care St Louis
- SSM Health Care St Louis
- SSM Health Care St. Louis
- SSM Health Care St. Louis
- SSM Health Care St. Louis
- SSM Health Care St. Louis
- SSM Health Slu Hospital Anesthesia Physician Billing, LLC
- SSM Home Care Private Duty
All providers in Saint Louis, MO · Emergency Medicine Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 2, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.